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  1. Article ; Online: Comparison of perioperative outcomes of retroperitoneal and transperitoneal minimally invasive partial nephrectomy after adjusting for tumor complexity.

    Gin, Greg E / Maschino, Alexandra C / Spaliviero, Massimiliano / Vertosick, Emily A / Bernstein, Melanie L / Coleman, Jonathan A

    Urology

    2014  Volume 84, Issue 6, Page(s) 1355–1360

    Abstract: Objective: To evaluate and compare perioperative outcomes of transperitoneal and retroperitoneal (RP) laparoscopic and robotic partial nephrectomies (LPNs) while adjusting for tumor complexity.: Materials and methods: Retrospective review was ... ...

    Abstract Objective: To evaluate and compare perioperative outcomes of transperitoneal and retroperitoneal (RP) laparoscopic and robotic partial nephrectomies (LPNs) while adjusting for tumor complexity.
    Materials and methods: Retrospective review was conducted of 191 patients who underwent transperitoneal (n = 116) or RP (n = 75) LPN. To adjust for tumor complexity, individual components of the radius, exophytic or endophytic properties, nearness to the collecting system or sinus, anterior or posterior location, and location in reference to polar lines (R.E.N.A.L.) nephrometry score were used in multivariate linear and logistic regression models to compare perioperative outcomes between the 2 groups. A propensity approach was also used to adjust for multiple covariates. Investigated outcomes included estimated blood loss (EBL), ischemia and operative times, length of hospital stay, margin status, opioid use, postoperative estimated glomerular filtration rate, complications within 30 days, and readmission rates.
    Results: Tumors resected by RPLPN were more likely to have lower complexity score by nephrometry (P = .04). Four of the 5 components of the R.E.N.A.L. nephrometry score were significantly different between the groups. After adjustment for these factors, a lower EBL was noted in the RP group (β, -97; 95% confidence interval, -156 to -39; P = .001). Risk of readmission for the RP group was significantly lower (odds ratio, 0.15; P = .024) using propensity analysis.
    Conclusion: Using adjustment for tumor complexity, RPLPN was associated with lower EBL and readmission rates supporting the potential clinical advantage for this approach when feasible.
    MeSH term(s) Aged ; Blood Loss, Surgical/physiopathology ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms/mortality ; Kidney Neoplasms/pathology ; Kidney Neoplasms/surgery ; Laparoscopy/methods ; Length of Stay ; Linear Models ; Logistic Models ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/methods ; Multivariate Analysis ; Neoplasm Invasiveness/pathology ; Neoplasm Staging ; Nephrectomy/methods ; Operative Time ; Perioperative Period/methods ; Peritoneum/surgery ; Retroperitoneal Space/surgery ; Retrospective Studies ; Risk Assessment ; Robotics/methods ; Survival Rate ; Treatment Outcome
    Language English
    Publishing date 2014-12
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 192062-5
    ISSN 1527-9995 ; 0090-4295
    ISSN (online) 1527-9995
    ISSN 0090-4295
    DOI 10.1016/j.urology.2014.07.045
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1142: Show issues Location:
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    Zs.MO 275: Show issues

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  2. Article ; Online: Intravenous Mannitol Versus Placebo During Partial Nephrectomy in Patients with Normal Kidney Function: A Double-blind, Clinically-integrated, Randomized Trial.

    Spaliviero, Massimiliano / Power, Nicholas E / Murray, Katie S / Sjoberg, Daniel D / Benfante, Nicole E / Bernstein, Melanie L / Wren, James / Russo, Paul / Coleman, Jonathan A

    European urology

    2017  Volume 73, Issue 1, Page(s) 53–59

    Abstract: Background: Mannitol is currently used as a renal protective agent to mitigate the effects of renal ischemia during nephron-sparing surgery (NSS). This routine practice lacks rigorous methodological study.: Objective: To assess the effect on renal ... ...

    Abstract Background: Mannitol is currently used as a renal protective agent to mitigate the effects of renal ischemia during nephron-sparing surgery (NSS). This routine practice lacks rigorous methodological study.
    Objective: To assess the effect on renal function outcomes after surgery of mannitol infusion prior to renal ischemia during NSS.
    Design, setting, participants: This prospective, randomized, placebo-controlled, double-blind trial included 199 patients with a preoperative estimated glomerular filtration rate (eGFR) >45ml/min/1.73m
    Intervention: Patients undergoing NSS were randomized to receive mannitol (12.5g) or placebo intravenously within 30min prior to renal vascular clamping.
    Outcome measurements and statistical analysis: The primary outcome was the difference in eGFR (renal function) between the two groups at 6 mo following surgery assessed with an analysis of covariance model using preoperative eGFR, treatment group, and surgical approach as covariates.
    Results and limitations: At baseline, the median age of the patients was 58 yr, and the median eGFR was 88ml/min/1.73m
    Conclusions: Intraoperative 12.5g mannitol infusion during NSS has no demonstrable clinical benefit when compared with standardized fluid hydration in patients with normal preoperative renal function, and its use in this setting is not warranted.
    Patient summary: In this randomized trial, patients with normal kidney function who received mannitol during surgery to remove part of their kidney had no better kidney function 6 mo after surgery than those who did not receive mannitol. We conclude that this routine practice should be discontinued.
    MeSH term(s) Aged ; Carcinoma, Renal Cell/pathology ; Carcinoma, Renal Cell/physiopathology ; Carcinoma, Renal Cell/surgery ; Diuretics/administration & dosage ; Diuretics/adverse effects ; Double-Blind Method ; Female ; Glomerular Filtration Rate/drug effects ; Humans ; Infusions, Intravenous ; Kidney/drug effects ; Kidney/pathology ; Kidney/physiopathology ; Kidney/surgery ; Kidney Neoplasms/pathology ; Kidney Neoplasms/physiopathology ; Kidney Neoplasms/surgery ; Male ; Mannitol/administration & dosage ; Mannitol/adverse effects ; Middle Aged ; Nephrectomy/adverse effects ; Nephrectomy/methods ; Organ Sparing Treatments ; Postoperative Complications/pathology ; Postoperative Complications/physiopathology ; Postoperative Complications/prevention & control ; Prospective Studies ; Time Factors ; Treatment Outcome
    Chemical Substances Diuretics ; Mannitol (3OWL53L36A)
    Language English
    Publishing date 2017-08-16
    Publishing country Switzerland
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 193790-x
    ISSN 1873-7560 ; 1421-993X ; 0302-2838
    ISSN (online) 1873-7560 ; 1421-993X
    ISSN 0302-2838
    DOI 10.1016/j.eururo.2017.07.038
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1247: Show issues Location:
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    Zs.MO 294: Show issues

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  3. Article ; Online: Second primary malignancies in renal cortical neoplasms: an updated evaluation from a single institution.

    Murray, Katie S / Zabor, Emily C / Spaliviero, Massimiliano / Russo, Paul / Bazzi, Wassim M / Musser, John E / Ari Hakimi, A / Bernstein, Melanie L / Dalbagni, Guido / Coleman, Jonathan A / Furberg, Helena

    World journal of urology

    2016  Volume 34, Issue 12, Page(s) 1667–1672

    Abstract: Purpose: To examine the incidence of secondary primary malignancies in patients with renal cortical neoplasms.: Methods: Between January 1989 and July 2010, 3647 patients underwent surgery at our institution for a renal cortical neoplasm and were ... ...

    Abstract Purpose: To examine the incidence of secondary primary malignancies in patients with renal cortical neoplasms.
    Methods: Between January 1989 and July 2010, 3647 patients underwent surgery at our institution for a renal cortical neoplasm and were followed through 2012. Occurrence of other malignancies was classified as antecedent, synchronous, or subsequent. All patients with antecedent malignancies (n = 498) and a randomly selected half of those with synchronous malignancies (n = 83) were excluded. The expected number of second primaries was calculated by multiplying Surveillance, Epidemiology, and End Results Program incidence rates of renal cortical neoplasms by person-years at risk within categories of age, sex, and year of diagnosis. The standardized incidence ratio (SIR) was calculated as observed cancers divided by expected incidence of the cancer, with approximation to the exact Poisson test used to obtain confidence intervals (CI) and p values.
    Results: Of 3066 patients with renal cortical neoplasms, 267 had a second primary cancer; the five most common in men were prostate, colorectal, bladder, lung, and non-Hodgkin's lymphoma; the five most common in women were breast, colorectal, lung, endometrium, and thyroid. Men demonstrated higher than expected thyroid cancer rate (SIR 5.0; 95 % CI 1.83-10.88, p = 0.002), and women had higher than expected rates of stomach cancer (SIR 5.0; 95 % CI 1.61-11.67, p = 0.004) and thyroid cancer (SIR 4.62; 95 % CI 1.69-10.05, p = 0.003).
    Conclusions: The incidence of certain types of second malignancies may be higher in patients after diagnosis of renal cortical neoplasms compared to the general population. These observations can inform clinical follow-up in kidney cancer survivorship and future research studies.
    MeSH term(s) Aged ; Carcinoma, Renal Cell/diagnosis ; Female ; Humans ; Incidence ; Kidney Cortex/pathology ; Kidney Neoplasms/diagnosis ; Lymphoma, Non-Hodgkin/diagnosis ; Lymphoma, Non-Hodgkin/epidemiology ; Male ; Middle Aged ; Neoplasms, Second Primary/epidemiology ; Retrospective Studies ; Risk Factors ; United States/epidemiology
    Language English
    Publishing date 2016-12
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 380333-8
    ISSN 1433-8726 ; 0724-4983
    ISSN (online) 1433-8726
    ISSN 0724-4983
    DOI 10.1007/s00345-016-1832-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1832: Show issues Location:
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  4. Article ; Online: Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems.

    Spaliviero, Massimiliano / Poon, Bing Ying / Aras, Omer / Di Paolo, Pier Luigi / Guglielmetti, Giuliano B / Coleman, Christian Z / Karlo, Christoph A / Bernstein, Melanie L / Sjoberg, Daniel D / Russo, Paul / Touijer, Karim A / Akin, Oguz / Coleman, Jonathan A

    World journal of urology

    2014  Volume 33, Issue 6, Page(s) 853–858

    Abstract: Purpose: To assess interobserver variability of R.E.N.A.L., preoperative aspects and dimensions used for an anatomical classification system (PADUA), and centrality index (C-Index) systems among observers with varying degrees of clinical experience and ... ...

    Abstract Purpose: To assess interobserver variability of R.E.N.A.L., preoperative aspects and dimensions used for an anatomical classification system (PADUA), and centrality index (C-Index) systems among observers with varying degrees of clinical experience and each system's subscale correlation with surgical outcome metrics.
    Methods: Computed tomography images of 90 patients who underwent open, laparoscopic, or robot-assisted laparoscopic partial nephrectomy were scored by one radiology fellow, two urology fellows, one radiology resident, and one secondary school student. Agreement among readers was determined calculating intraclass correlation coefficients. Associations between radiology fellow scores (reference standard as reader with greatest clinical experience), ischemia time, and percent change in postoperative estimated glomerular filtration rate (eGFR) were evaluated using Spearman's correlation.
    Results: Agreement using C-Index method (ICC = 0.773) was higher than with PADUA (ICC = 0.677) or R.E.N.A.L (ICC = 0.660). Agreement between reference and secondary school student was lower than with other physicians, although the differences were not statistically significant. The reference's scores were significantly (p < 0.05) associated with ischemia time on all three scoring systems and with percent change in eGFR at 6 weeks using C-Index (p = 0.016). Tumor size, nearness to sinus, and location relative to polar lines (R.E.N.A.L.) and tumor size, renal sinus involvement, and collecting system involvement (PADUA) correlated with ischemia time (all p ≤ 0.001). No R.E.N.A.L. or PADUA subscales significantly correlated with percent change in postoperative eGFR.
    Conclusions: Clinical experience reduces interobserver variability of existing nephrometry systems though not significantly and less so when using directly measureable anatomic variables. Consistently, only measures of tumor size and distance to intrarenal structures were useful in predicting clinically relevant outcomes.
    MeSH term(s) Aged ; Anthropometry ; Carcinoma, Renal Cell/diagnostic imaging ; Carcinoma, Renal Cell/pathology ; Carcinoma, Renal Cell/surgery ; Cohort Studies ; Fellowships and Scholarships ; Female ; Humans ; Internship and Residency ; Kidney/diagnostic imaging ; Kidney Neoplasms/diagnostic imaging ; Kidney Neoplasms/pathology ; Kidney Neoplasms/surgery ; Laparoscopy ; Male ; Middle Aged ; Nephrectomy ; Observer Variation ; Outcome Assessment, Health Care ; Radiology/education ; Retrospective Studies ; Robotic Surgical Procedures ; Schools ; Students ; Tomography, X-Ray Computed ; Tumor Burden ; Urology/education
    Language English
    Publishing date 2014-08-24
    Publishing country Germany
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 380333-8
    ISSN 1433-8726 ; 0724-4983
    ISSN (online) 1433-8726
    ISSN 0724-4983
    DOI 10.1007/s00345-014-1376-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1832: Show issues Location:
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